NBCE Part IV: Which States Require It, and What Changed in 2026

NBCE Part IV is required for exam-route licensure in most states we have checked, including Florida, Texas, California, New York, Montana, Nevada, Alaska and Nebraska. A few states let a different exam stand in for it, usually SPEC for an experienced doctor or a state clinical exam taken years ago. And since April 2026, every new Part IV sitting happens in one place: the NBCE Assessment Center in Greeley, Colorado.

What is Part IV?

Part IV is the National Board of Chiropractic Examiners' practical exam. Parts I, II and III and the Physiotherapy exam are computer-based; Part IV puts the candidate in a room with a trained simulated patient. New York's Office of the Professions describes it plainly on its chiropractic requirements page: Part IV "is an oral/practical examination that measures hands-on skills."

The NBCE rebuilt the exam for 2026. According to the NBCE's Part IV exam page, the new version has seven case management encounters and one technique station:

• Case management stations (7). A 2-minute door chart review, a 14-minute patient encounter, then 6 minutes to write a SOAP note. Each encounter runs from history through examination to a treatment decision.
• Technique station (1). The same 2-minute chart review, then 14 minutes to set up 10 chiropractic adjustments. No note.

The old format used 25 short stations and a multiple-choice post-encounter station. The NBCE's Part IV Advancement and Development FAQ (April 2025) explains the change: the written note replaces the multiple-choice station, and every encounter is video-recorded for scoring quality assurance, with the recording replacing an examiner in the room.

Which states require Part IV for a first license?

These are the states where we have read the statute, rule or board page ourselves, as of October 2026:

• Florida. Fla. Stat. § 460.406(1)(e) requires NBCE Parts I, II, III and IV plus Physiotherapy, and Rule 64B2-11.001 sets 375 as the passing score on each. See our Florida page.
• Texas. 22 Tex. Admin. Code § 72.6 requires Parts I, II, III, IV and Physiotherapy, each at 375. See Texas.
• California. 16 CCR § 349(b) defines "National Board status" as passing Parts I, II, III, IV and Physiotherapy, and adds the California board exam. See California.
• New York. The NYSED requirements page lists Parts I, II, III and IV for licensure by examination. Physiotherapy is not required. See New York.
• Montana, Nevada and Nebraska. Each requires Parts I through IV plus Physiotherapy for the exam route (Mont. Admin. R. 24.126.301; NRS chapter 634; 172 NAC 29-003).
• Alaska. Graduates after September 1, 1998 need Parts I through IV and Physiotherapy under 12 AAC 16.037.

Which states accept something other than Part IV?

This is where the rules get specific, and where an experienced DC moving states usually has more options than a new graduate:

• Arizona asks for Parts I and II plus a passing score on Part III or Part IV (A.R.S. § 32-921), so a candidate can qualify without Part IV.
• Alabama accepts Parts I through IV, or Parts I and II plus SPEC (Ala. Admin. Code r. 190-X-2-.01).
• Alaska lets a DC with five continuous years of practice substitute SPEC for Parts III and IV.
• Nebraska lets a DC licensed and practicing elsewhere qualify with Parts I, II and Physiotherapy plus SPEC instead of Parts III and IV (172 NAC 29-003.01(C)).
• Texas lets an out-of-state licensee use SPEC at 375 in place of the full NBCE series, along with three years of practice (22 Tex. Admin. Code § 72.20).
• New York endorsement applicants need only Parts I and II if the department accepts a state-administered clinical competency exam they passed elsewhere, plus two years of practice in the last five. Without any practical exam on record, the alternative is SPEC plus seven of the last ten years in practice.

Read those carefully. Each substitute applies to a specific kind of applicant, usually one who already holds a license and has practiced for years. A new graduate cannot skip Part IV in any state that requires it. More on the SPEC route in the SPEC exam: who has to take it and when.

Who is eligible to sit for Part IV?

Per the NBCE's Part IV page, a candidate is eligible once they have passed Part I, are within 6 months of graduation or have graduated from an eligible chiropractic college, and can get the college registrar's online authorization. A doctor licensed on or before December 31, 1997 does not need to have passed Part I to apply.

The NBCE also states that a candidate who has already passed Part IV is not eligible to retake it unless a state board requires it. That matters for older licensees whose scores a board will not accept: the board has to ask.

What does the move to Greeley change for an application timeline?

The NBCE's planning page set the first live exam at the Greeley Assessment Center for April 10, 2026, with a final campus-based administration on May 16 and 17, 2026. Testing now runs on a rolling schedule; the NBCE says the center offers exam appointments 48 weeks a year, where the old campus model ran twice a year.

Practical effects for anyone planning a license:

• Book early in the fall. The NBCE says October through December are the most popular months, and appointments can be made up to six months ahead. Scheduling closes 17 days before each test date.
• Budget for travel. The exam fee is $1,585 on the NBCE fee schedule. The NBCE's own FAQ estimated an average of $427 in airfare and one night's lodging for examinees who used to test on campus, and it runs a shuttle from Denver International Airport.
• Plan for the score wait. The NBCE's FAQ estimated about four weeks to receive a score, after which a failed candidate can reapply. Most boards want the official transcript, so the license file cannot close until that score posts and the transcript is sent. See sending NBCE scores to a new board.

How should an already-licensed DC think about Part IV?

If you passed Part IV years ago, it is on your NBCE transcript and you are done with it unless a board says otherwise. If you never took it, start with the target state's out-of-state route rather than the exam route. Texas, Alabama, Alaska and Nebraska all accept SPEC from qualifying licensees in place of Parts III and IV or the full series, and New York accepts an earlier state clinical exam for endorsement. Sitting for Part IV in Greeley makes sense mainly when the target state offers no substitute for someone with your history, or when you are reactivating a long-inactive Texas license, where the rule names Part IV and SPEC as alternatives (22 Tex. Admin. Code § 72.16(g)). Compare the costs too: Part IV is $1,585 plus travel, SPEC is $1,500 and is given at Prometric centers across North America.

Does Part IV ever expire?

The NBCE does not put an expiration date on a passing score, but boards can decide how old is too old. Florida may require SPEC from an applicant who graduated more than 10 years before applying (Fla. Stat. § 460.406). Nebraska requires SPEC within the last three years from an applicant whose scores are more than three years old and who is not practicing elsewhere. We cover these rules in older NBCE scores and degrees.

How we help

We do not prepare anyone for Part IV, and nobody can promise a pass. What we do is tell you, before you book a flight to Colorado, whether the state you want actually needs Part IV from you, or whether your existing license, practice history or a SPEC score opens a different route. Our Chiropractic Licensure Readiness Review ($149) answers that for one or more states, and the Full State License Application ($749 per state) manages the file through approval. NBCE and board fees are separate. Every state's requirements are on our state license index.